The main finding
In one sentence: In a trial in Qatar, younger adults with recently diagnosed type 2 diabetes who followed an intensive lifestyle program lost an average of 11.98 kg over 12 months, compared with 3.98 kg with usual care, and 61% reached diabetes remission compared with 12%.
Group averages, not an individual prediction. A trial result describes what happened to a defined group over a defined time.
On this page
Why this study matters
Type 2 diabetes is being diagnosed at younger ages, especially in some regions and communities. Canada's population includes many people with roots in the Middle East and North Africa. DIADEM-I tested whether a structured lifestyle program, similar in design to the UK DiRECT trial, could produce large weight loss and put early diabetes into remission in younger adults from this region.
Who was in the study
The trial enrolled 158 adults aged 18 to 50 years who were from the Middle East and North Africa region. All had type 2 diabetes for three years or less and a BMI of 27.0 or higher. BMI is weight in kilograms divided by height in metres squared. The study was done in primary care and community settings in Qatar. Enrolment ran from July 16, 2017, to September 30, 2018. Of the 158 people randomized, 79 to each group, 147 were included in the final analysis: 70 in the lifestyle group and 77 in the usual-care group. The trial lasted 12 months.
What the researchers did
This was an open-label, parallel-group, randomized controlled trial. Randomized means a computer-generated sequence assigned people to groups by chance. Open-label means people knew which group they were in. Parallel-group means the two groups ran side by side over the same period.
The intensive lifestyle program had three phases. First, a total diet replacement phase, in which participants used formula low-energy meal replacement products. Second, gradual reintroduction of ordinary food, combined with physical activity support. Third, a weight-loss maintenance phase with structured lifestyle support.
The comparison group received usual diabetes care based on clinical guidelines. No weight-loss medicine was part of either group.
The main outcome was weight loss at 12 months. Key secondary outcomes included diabetes control and remission. The analysis followed the intention-to-treat principle, meaning people were counted in the group they were assigned to.
What they found
Between the start and 12 months, average body weight fell by 11.98 kg (95% confidence interval 9.72 to 14.23) in the lifestyle group and by 3.98 kg (2.78 to 5.18) in the usual-care group (R32-C110). The adjusted difference was -6.08 kg (95% confidence interval -8.37 to -3.79), where the minus sign means more weight lost with the program. A confidence interval is the range within which the true value would likely fall.
| Result at 12 months | Lifestyle program | Usual care |
|---|---|---|
| Average weight loss | 11.98 kg | 3.98 kg |
| Lost more than 15% of starting weight | 21% | 1% |
| Diabetes remission | 61% | 12% |
| Normal blood sugar (normoglycaemia) | 33% | 4% |
The odds ratio for remission was 12.03 (95% confidence interval 5.17 to 28.03). For normal blood sugar it was 12.07 (3.43 to 42.45). An odds ratio compares the odds of an outcome between two groups. The published summary does not spell out the exact definition of remission used in this trial.
Side effects and people who stopped
Five serious adverse events were reported in four people in the usual-care group. Four were hospital admissions for unexpected events: a fast heart rhythm, abdominal pain, pneumonia, and a testicular infection. One was a hospital admission for high blood sugar, which was an anticipated event. The summary does not describe serious adverse events in the lifestyle group. Of 158 people randomized, 147 were in the final analysis, so 11 people were not included. The summary does not explain why.
What this study does not tell you
- Participants were young, recently diagnosed, and from one region. Results may differ for older people, longer-standing diabetes, or other populations.
- The trial was open-label, so people knew their group, which can influence behaviour and reporting.
- The final analysis included 147 of 158 randomized people, and the summary does not say how missing data were handled.
- The program was delivered with clinical support in a study setting. It says nothing about stopping diabetes medicines outside supervised care.
- Twelve months is a short follow-up. The summary does not report what happened after the program ended.
- Our summary is based on the abstract and extracted data, not the full paper.
What it means in Canada
DIADEM-I adds to evidence from DiRECT that a structured lifestyle program can produce large weight loss and diabetes remission for some people early in the disease. It was run in Qatar with a younger, regional population, so Canadian results could differ. It used no weight-loss medicine. For medicines used in type 2 diabetes care in Canada, see semaglutide in Canada and tirzepatide in Canada. For coverage, see public drug coverage by province. To find structured programs, see compare services.
Common questions
How much weight did people lose in DIADEM-I?
Average weight loss at 12 months was 11.98 kg in the lifestyle group and 3.98 kg with usual care, an adjusted difference of -6.08 kg.
What share of people reached diabetes remission in DIADEM-I?
61% of the lifestyle group and 12% of the usual-care group had diabetes remission at 12 months.
Who took part in DIADEM-I?
Adults aged 18 to 50 from the Middle East and North Africa region with type 2 diabetes for three years or less and a BMI of 27 or more, studied in Qatar.
Related reading
Other studies in this library that bear on the same question.
DiRECT trial: can type 2 diabetes go into remission in one year?
DiRECT at two years: did diabetes remission last?
Look AHEAD at one year: lifestyle support in type 2 diabetes
ACHIEVE-1: orforglipron in early type 2 diabetes
Source
Original paper: Shahrad Taheri, DIADEM-I, The lancet. Diabetes & endocrinology, 2020. PubMed: https://pubmed.ncbi.nlm.nih.gov/32445735/. DOI: https://doi.org/10.1016/S2213-8587(20)30117-0. Funding: The study was funded by the Qatar National Research Fund. How we summarized it: abstract and extracted data.
This page explains a published study. It is not medical advice and does not describe whether a medicine is right for you. Talk to your doctor, nurse practitioner or pharmacist about your own situation. Reviewed and signed by two pharmacists registered in British Columbia, 2026-09-18.
Evidence records behind this page
Each record is a row in the clinical evidence file, taken from the published paper named above. The caution column is the limit the researcher recorded for that number.
This table scrolls sideways.
| Record | What the paper reports | Type | Population | Caution | Source |
|---|---|---|---|---|---|
| R32-C110 | In DIADEM-I, younger adults with recently diagnosed type 2 diabetes assigned intensive lifestyle support lost a mean 11.98 kg at 12 months versus 3.98 kg with usual care; remission was reported in 61% versus 12%. | direct evidence | Adults 18 to 50 years from Middle East/North Africa with T2D≤3 years and BMI≥27, studied in Qatar | Young, recent T2D and regional population; open-label; incomplete final ITT denominator. No inference about medication withdrawal outside supervised study. | PubMed 32445735 |